The focus of the Institute for Health Care Improvement was on process improvement.
We took the grant's mandate seriously but not IHI's method. We asked patients with serious chronic medical conditions what they needed. We asked their families what they needed. We ask front line providers, doctors and nurses and pharmacists, what they needed.
The three key innovations for the patients and their families were: 1) Community Health Workers, 2) a personally controlled medical record that can be selectively shared with anyone the patient chooses, and 3) ongoing learning about managing their own medical condition.
We build a sophisticated model of the system that confirmed that these simple innovations would save lives and money and that no part of the system would be significantly negatively impacted.
However, no institution wanted to implement the simple common sense inventions because the result was increased health, decreased expenditure.
Also the key invention created a new role, the neighborhood health worker-- a non-degreed health support person. There continues to be much fighting over who controls this role, when it is clear that it should be the neighborhoods themselves. The solution would have made practicing medicine much more emotionally rewarding and less frustrating for doctors, nurses, and pharmacists. It would have saved Medicare billions of dollars over 15 years in my county alone. It was simple to understand and simple to implement.
The profound disregard for this hard won innovation led me to shift my focus toward health creation and maintenance, toward the so called "social determinates of illness" or better yet the neighborhood determinates of health. Working in the US medical industrial complex was not delivering on what the patients I met during Pursuing Perfection were asking for. I owe them my best effort.
The US health care system I knew has gradually been replaced by an extractive business too often taking more than it gives back. US Health Care is not a very good deal. It often impoverishes, ignores, and too frequently kills. I am not a fan of this worsening situation. Health needs to be largely disentangled from medical care and prevention through neighborhood created health. Medical care should be left for illness care. Public health should guide prevention. Neighborhoods can and must provide active, meaningful and healthy living.
The purpose of the system is the issue. The purpose determines the structure. The structure determines the roles. People fill the predetermined roles. Change the purpose. Don't try to change the people or minds until you have changed the purpose from profit taking to human wellbeing and neighborhood wellbeing.